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APPLICATION A� N—D� CERTIFICATE FOR PAYMENT AiA DOCUMENT G702 ( I I1.S I r ne [ 10 11 a or revere ai ilei IMI L: 1 fN Il 1Ir
<br /> ooWNr-. u : � A /L2(/ / P • nLliJ1��S gnscT: A't' r
<br /> ZAt ` T� AI ' I' I . ICA"ZION NO. : aZ CNi� I , nli in
<br /> /��, y r (suloD 'ro : fI�R1 / .Z S, adl9 �s4srlvDlc
<br /> PROJECT NOS . : ❑ AliClll 'IF ( :'I
<br /> FROM CONI RACT01? CI CUNT RACI 'Ult
<br /> -X/ /! [(��/ y�[/�_�/ VIA AllCHITEC'I': / k[ X///, '?/'1 72'9 CON 'fRAC"I ' UAFG : I,
<br /> ���� C7 l�l(I{a�-/A�/Z ,I.��UCrry p/V ,� J/�.�� /��J��,,r��.�'�,� �Y ❑
<br /> CONTRACT f'CSrf. : x .�.JA' 7. �� ... vS 7Q]J !'C-d � i'Jc/.0—/ JG. ✓I�J�
<br /> CONTRACTOR ' S APPLICATION FOR PAYMENT 'I Ile undersigned Contr:Iclor cenifies thm to the best of the Cuntraclor ;ahn< Iwlcdgc, infor-
<br /> ApPlicaunn I5 made for payment , as shown below, in connection with the Contract , in Ili oro Ida 1�el Withief tile d cOGo n��:ere Doeumcld by
<br />this �ls ptilcltti011 amotmts hul�eab�en p d byewd
<br /> Cunnnuatiun Sheet , AIA Document G7U3 , is attached .
<br /> the
<br /> Contractor for Wolk for which previous Certificates for Payment were issued and pay .
<br /> I . ORIGINAL CONTRACT SUNT . . . . . . p � ments received from the Owner, and that Current payment shown herein is
<br />now due.
<br /> . . . . . . . . . .
<br /> -' . Net change by Change Orders . . . . B / '� � f CONTRACTOR ,,766�A/0.4,0� �
<br /> i . CON "FHAC:T SUM TO DATE Line
<br /> ,i . TOTAL COMPLETED & STORED TO DALE . . . . , , 8 7Q 9,j j Ly
<br /> ( Column G on 6703 ) - state t .,
<br /> County of:
<br /> 5 . RETAINAGE :
<br /> y0933� subscribed and sN01'Ia to dor —7
<br /> ul Cunaplc tG \3 ) g / C> // O'
<br /> ( Culunins D r G On G7U3 ) 1 Inc this day
<br /> b. _ 96 of stored Material g
<br /> ( Culunin F on 0703 ) _--_— - C nl
<br /> Intal Retainage ( Linc 5a + 5b or Noutry Public : yCommisslon Op1808De
<br /> Total in Column I of C. l03 ) 8 My Commission expires : ^� Expires Februa
<br /> . . —. rY 18, 2007
<br /> -__
<br /> TOTAL EARNED Less ReTAINAGE . . . . . . , , , . . g /�� $ ya , Y,
<br /> ( Line i less Line 5 Tom [) ARCHITECT ' S CERTIFICATE FOR PAYMENT
<br /> 7 . ( LineLESS PREVIOUS CERTIFICATES FOR PAYMENT" In accordance with the Contract Documents, based on on -site observations and the
<br /> Uata
<br /> ti . CURRENT PAYMENT
<br /> Certificate) ,j� � 5
<br /> 6 From P � " � � � � � � � � A � _ comprising [ his application , the Architect certifies to rhe Owner that
<br /> to the best of ( lie
<br /> DUE . . . . . . . p �- Architect 's knowledge, information and belief the Work has progressed as indicated , the
<br /> yunlity of the ¢vork is In atc0rdancc wlrh the Conuacr documents, and the coml;lclor
<br /> 9 . BALANCE r0 FINISH , INCLUDING RETAINAGE is entitled to payment Of the AMOUNT CERTIFIED.
<br /> ( Line 9 less Line 6) AMOUNT CERTIFIED
<br /> _ . � _
<br /> CtNEORDER SUNSN9ARl' ADDITIONS (Attach ecp/nnglion if nnlounl terrified drff'ers from !be anroeuu applied fo[ Inirinl
<br /> DEDUCTIONS a/1 /igures nre Ibis Appiicolio n aid an Ole Conlimraho )7 Sbeet lhal are dlanged to
<br /> ges upProved illPmonths by Owner collfolrn ro the elmoilt culorlied, )
<br /> Total 1pploved this Month ARCHI 'fEC1 ';
<br /> _ B ) __
<br /> TOTALS "Ph Ls Cer[ ifi ca re is not Ile Date : _
<br /> NEl ' CI-IANIG GS by Cha nge . OrUcr — f,otiable, 'ihe AMOUNT CERTIFIED is Parable Drip to the Con "
<br /> IGIc U1r named herein . Issuance, p ,Iymenl incl nc'cepP,tnce of p:Iynaent are without
<br /> prejudice ut :uay rights of die Owner or Contractor under this COnuact .
<br /> \`1( �l AIA DOCUMENT G702 • APPU01TlON AND CF. Id IFICAIF. FOR PA) NIENT 1992 GDII'ION AIA"' © 1992 • THE AMERICAN IN,S111 LIFE OF
<br /> ARCIIITECTS, 1715 NEW PORK
<br /> g .1\' FNt 't, N \('.. \\N$IIIN(;IUN, p.(:. 211uI1L. S n)] WARNING: Unlicensed holaco
<br /> -- p pying violates U.S. copyright laws and will suLleci the vlolalor to legal prosecfilar.
<br /> G702 -1992
<br /> CAUTION : You should use an original AIA document which has Ihls caullon printed In red . An nseu original 9 res that changes will not be obscured as
<br /> may occur when documents are reproduced .
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